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Contracting Provider Specialist

Company: Renown Health
Location: Reno
Posted on: July 12, 2019

Job Description:

Contracting Provider Specialist Position Purpose: Under the general guidance of the Contract Manager-Hometown Health, this position provides day to day management of existing contract arrangements with providers and their respective office staff. This includes timely and accurate response to all provider requests and/or concerns.The incumbent is also primarily responsible for outreach and education of contracted providers and staff in regards to Hometown Health policies and procedures.Nature and Scope: The Contracting Provider Specialist will have the responsibility of the relationship between Hometown Health and existing contracted community providers and their staff. This will include many of the following responsibilities:Have a good understanding of healthcare contracting and be seen as the \"go-to\" representative for our contracted providers and their staff. Develop and manage provider relationships demonstrating a customer service approach while adhering to Hometown Health and Renown Health policies and procedures. Identifies/researches and resolves issues including claims, fee schedules, benefit eligibility, and reconsiderations. Coordinates internal and external resources to resolves issues/problems for providers. Assists the Contract Manager in monitoring the provider's performance based on utilization patterns, and other quality standards. Organize and facilitate all educational materials and/or classes to contracted providers and their staff including onsite presentations. Assists in process improvement based on feedback from providers to enhance the quality of care of Hometown Health members and the customer service level of the provider. Provide communication/education to providers in regards to Hometown Health Customer feedback/concerns. Provide communication to Hometown Health departments in regards to feedback/concerns provided by providers and their staff to improve overall quality. Possess functional knowledge of medical coding in regards to the contract requirements.This position does not provide patient care. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications: Requirements - Required and/or Preferred Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. A Bachelor's Degree in a business related field is preferred. Experience: Three years in a health care environment with at least two years in contracting required. Provider and/or health plan contracting preferred. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Keywords: Renown Health, Reno , Contracting Provider Specialist, Other , Reno, Nevada

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